When you have facial palsy — whether it’s from Bell’s palsy, trauma, or another neurological condition — everyday things like blinking or fully closing your eye can become difficult. Now add in something like cataract surgery, and it’s completely understandable if you’re feeling nervous about how that’s going to work. After all, blinking and proper eyelid function help protect your eye. So what happens when those functions are impaired?
The good news is that cataract surgery is still very much possible for people with Bell’s palsy. You’re not alone, and surgeons are well-versed in managing these types of cases. But there are important things to know — because while the cataract procedure itself may be the same, your surgeon will take special steps before, during, and after surgery to help keep your eye protected, comfortable, and healing smoothly.
Let’s walk through everything you need to know if you’ve got facial palsy and are considering cataract surgery.
What Is Facial Palsy and How Does It Affect the Eye?
Facial palsy refers to weakness or paralysis of the muscles on one side of the face, most often due to damage or inflammation of the facial nerve. Bell’s palsy is the most common cause and often comes on suddenly, causing drooping of the mouth and difficulty with facial expressions. One of the key issues is that it can stop the eyelid from closing properly — a condition called lagophthalmos.
Why does this matter for eye surgery? Well, blinking and eyelid closure are essential for lubricating and protecting the cornea. When these mechanisms don’t work, the eye can dry out, become irritated, or even develop exposure-related damage. For someone undergoing cataract surgery, these challenges mean the cornea is more vulnerable, both during the operation and in the days and weeks that follow.
So, while the cataract itself might be very straightforward, your eye’s surface — and the way your eyelids function — becomes the more critical issue to plan around.
The Main Concerns for Cataract Surgery in Facial Palsy Patients
There are three key concerns that cataract surgeons watch for closely when operating on a patient with facial palsy:
1. Exposure Keratopathy and Dry Eye Risk
Without proper eyelid closure or blink reflex, your eye is constantly exposed to the air. This can lead to exposure keratopathy — essentially, the cornea becoming dry, inflamed, and vulnerable to abrasions. Cataract surgery involves a small incision in the eye and temporary changes to the tear film, which can exacerbate dryness. If you’re already at risk due to facial palsy, this becomes an important part of your care plan.
Surgeons will typically assess your corneal health in detail pre-op. In some cases, you might be started on lubricating drops, gels, or even protective ointments before surgery to improve the surface condition of the eye. If the corneal surface is unhealthy, surgery might be postponed until it’s in better shape.
2. Intraoperative Protection of the Eye
During the procedure, protecting the cornea and maintaining eye moisture are vital. Normally, you’re asked not to blink — but with facial palsy, the eye may not close fully even when you want it to. This can lead to corneal drying or damage during the operation. To counter this, the surgeon may use additional lubricants during surgery, place a protective shield over the exposed parts of the eye, or gently tape the upper lid into a better position during the operation.
Anaesthetic choice also matters. Local anaesthesia (typically a numbing injection near the eye) is common for cataract surgery, but in facial palsy cases, your surgeon will adjust the anaesthetic technique to preserve whatever muscle tone remains in the eyelids. This ensures you don’t worsen any lid weakness post-op.
3. Postoperative Healing and Infection Risk
After surgery, a key concern is making sure the eye stays well-lubricated and protected while it heals. Since the incision is tiny and no stitches are normally used, the eye relies heavily on its natural defences — blinking, tears, and lid closure — for a smooth recovery. If those aren’t working optimally, healing may be slower, and the risk of infection or corneal complications goes up.
That’s why you’ll likely be prescribed more than the standard post-op drops. Your surgeon might give you a lubricating ointment to use at night, recommend wearing an eye shield longer than usual, or even suggest temporary lid taping during sleep to keep the eye from drying out. These steps aren’t complicated, but they make a big difference to recovery.
Pre-Surgical Planning: The Role of the Oculoplastic Surgeon
In some cases, an oculoplastic surgeon — a specialist in eyelid and orbital surgery — may be involved. If you have long-standing facial palsy with severe lagophthalmos (inability to close the eyelid), the oculoplastic surgeon might recommend a minor procedure before the cataract surgery to help protect the eye.
This could include:
- Tarsorrhaphy (temporary or partial eyelid closure via stitching)
- Gold weight implantation in the upper lid to help gravity close the eye
- Botulinum toxin injections in opposing eyelid muscles to balance closure
These procedures aren’t always necessary. But if your eye is significantly exposed or dry, or if there are signs of corneal damage, they can help optimise the eye surface and reduce risk.
Anaesthesia Choices and Facial Palsy Considerations
If you have facial palsy, your anaesthetic plan might be slightly different. The standard approach for cataract surgery is local anaesthesia — usually a small injection around the eye to numb the area, sometimes with a light sedative.
But here’s where it gets interesting: if your facial nerve is already impaired, your anaesthetist and surgeon need to be extra cautious not to further affect any residual eyelid movement. This is particularly true in patients with partial recovery from Bell’s palsy, or in those with synkinesis (where different facial muscles move involuntarily together).
Your anaesthetist may choose a peribulbar or sub-Tenon’s block (types of local injections) with modified technique, ensuring minimal spread to the facial nerve. This preserves whatever blinking function remains — critical for your recovery.
Postoperative Eye Care: Tailored to Your Needs
Once the surgery is complete, your postoperative plan is going to look slightly different from someone without facial palsy. Your surgeon will want to make sure the cornea stays moist and protected, and that your healing is on track. This might include:
- Frequent use of preservative-free artificial tears
- Antibiotic and anti-inflammatory drops, as standard, but used alongside lubricants
- Nighttime eye ointment or gels to prevent dryness while sleeping
- Lid taping or moisture goggles, especially if you have trouble closing the eye at night
- Longer-term follow-up, especially if you’re at risk for exposure keratopathy or corneal issues
It’s also important to protect the eye from physical injury. If you can’t blink reflexively, small particles like dust can cause more harm than usual. You might be advised to wear glasses outdoors, or even a clear eye shield for extra safety.
Bell’s Palsy: Temporary or Permanent — Does It Change the Surgical Plan?
Not all cases of Bell’s palsy are permanent. In fact, many people recover fully or partially within weeks or months. But whether your Bell’s palsy is new or has been around for a while, your cataract surgeon still needs to treat it as a factor that could influence your eye protection and healing. Why? Because even temporary facial palsy can reduce your ability to blink or close your eye fully — and until that improves, the eye is more vulnerable.
If your Bell’s palsy has just started, your surgical team might suggest postponing the cataract procedure for a few weeks to see if your eye closure improves. On the other hand, if you’ve had it for a long time with no further recovery expected, they’ll move forward with a tailored plan to protect your eye throughout the process. The point is, whether Bell’s palsy is short-term or long-term, the right strategy is always about working with your current eyelid function — not waiting endlessly for things to go back to normal.
This is why open communication with your surgical team is essential. Let them know if you’re using lubricating drops already, whether your eye waters a lot or feels dry, and if you’ve noticed changes in how you sleep or wake up with irritation. These details help guide your surgical plan — and ensure your recovery is just as safe and effective as anyone else’s.
What If Bell’s Palsy Affects Both Eyes Over Time?
Most cases of Bell’s palsy only affect one side of the face. But if you’re someone who has had bilateral facial nerve issues over time — whether due to recurrent Bell’s palsy, Lyme disease, or another neurological condition — both eyes may be compromised to some degree. This can complicate things slightly, but it absolutely doesn’t rule out cataract surgery.
In these situations, surgeons pay even more attention to corneal protection. With reduced blink reflexes in both eyes, you may already be using artificial tears, night ointments, or eye shields — and these become even more important after cataract surgery. You might also need to continue using these protective treatments long after your surgical wounds have healed, especially to preserve sharp vision and comfort in the long term.
If both eyes require cataract surgery, your surgeon will likely space the procedures out a little longer than usual, so they can monitor your recovery and surface protection from the first eye before moving to the second. And if your Bell’s palsy is part of a broader neurological picture, the surgeon may consult with your neurologist to coordinate care. Again, it’s all about thoughtful planning — not rushing — and making sure your outcomes match your expectations.
Vision Outcomes: Will Cataract Surgery Still Work?
Yes — cataract surgery can still be just as effective in people with facial palsy. As long as the cornea is healthy and the surgery goes smoothly, the visual improvement can be excellent. The cataract affects the lens inside your eye, and facial palsy doesn’t interfere with that directly.
However, if the cornea is dry or damaged, that can blur your vision — so managing surface health is just as important as fixing the cataract itself. In many cases, patients with facial palsy experience just as much benefit from surgery, provided that appropriate precautions are taken throughout the process.
FAQs
- Can I have cataract surgery if I can’t fully close one eye due to facial palsy?
Yes, you can still have cataract surgery even if you have lagophthalmos (incomplete eyelid closure). Your surgeon will take steps to protect your cornea both during and after the procedure, often using additional lubricants, shields, or involving an oculoplastic specialist if needed. - Will facial palsy affect my vision after cataract surgery?
Facial palsy itself doesn’t affect the inside of the eye or the lens, so the cataract can still be removed effectively. However, dryness or corneal irritation caused by poor eyelid closure can blur vision — which is why postoperative care for the eye surface is so important. - Do I need extra treatment before surgery if I have Bell’s palsy?
Not always, but if your eyelid doesn’t close properly or your cornea shows signs of dryness or damage, your ophthalmologist might recommend pre-surgical measures like lubrication or even a minor eyelid procedure to help prepare the eye for surgery. - Can I wear a patch or eye shield after surgery?
Yes, and in fact, it’s often recommended for patients with facial palsy. An eye shield can protect the eye during sleep or in windy or dusty environments while healing takes place, especially if you can’t blink fully or close your eye tightly. - What kind of anaesthesia is used in facial palsy patients?
Most often, local anaesthesia is still used, but with care taken to avoid affecting the already weakened facial nerve. Anaesthetists will adapt the injection technique to preserve any residual eyelid movement and avoid further muscle weakness. - How long does recovery take after cataract surgery in people with facial palsy?
Recovery timelines are generally similar to those in other patients, but extra care is required for corneal protection. You may use lubricants or ointments for a longer period and have closer follow-up appointments to monitor the healing process. - Is there more risk of infection after cataract surgery if I have facial palsy?
There’s a slightly higher risk if the eye doesn’t close well, as it’s more exposed to environmental contaminants. But with proper postoperative hygiene, lubrication, and sometimes protective measures like taping the eyelid, this risk is manageable. - Should I delay cataract surgery until my facial palsy improves?
Not necessarily. If your facial palsy is longstanding or not expected to fully recover, delaying surgery may not bring any benefit. Instead, your surgeon will plan for the current condition of your eye and adjust accordingly to ensure safety and comfort. - Can cataract surgery worsen my facial palsy?
Cataract surgery itself does not affect the facial nerve, so it doesn’t worsen facial palsy. However, careful anaesthetic planning is important to avoid accidental spread of numbing medication to the facial nerve area, especially if you still have partial function. - How do I find a cataract surgeon experienced with facial palsy cases?
Look for clinics with subspecialty expertise in both cataract and oculoplastic surgery, or those that work in close coordination with neurologists and facial palsy specialists. At London Cataract Centre, we offer tailored care plans for patients with facial nerve issues and complex eye conditions.
Final Thoughts
Facial palsy adds an extra layer of complexity to cataract surgery — but it absolutely doesn’t mean you can’t have it, or that you won’t do well. The key lies in individualised care. Surgeons who are familiar with managing facial nerve dysfunction will adjust every step of the process — from lubrication and eye protection to anaesthesia and postoperative follow-up — to suit your needs.
At London Cataract Centre, we regularly see patients with facial palsy and related eye conditions. We take the time to coordinate with your GP, neurologist, or oculoplastic surgeon if needed, and make sure you feel supported every step of the way. If you’re dealing with facial weakness and wondering how to proceed with cataract surgery, just know — there’s a plan for you, and it starts with the right conversation.
References
- EyeWiki (2025) Facial Nerve Palsy.
- JAMA Ophthalmology (2010) Lin, I.-C. et al. ‘Documentation of Conformance to Preferred Practice Patterns in Caring for Patients With Dry Eye’. JAMA Ophthalmology, 128(5), pp. 619–623.
– Emphasises the need for adherence to dry eye care protocols—especially relevant for pre- and postoperative eye surface health. - Thieme Connect (2025) Management of the Eye in Facial Paralysis, Seminars in Plastic Surgery, 31(1), pp. 31–38.
– Covers advanced therapeutic options (e.g., botulinum, tapes, weights, tarsorrhaphy) for ocular protection in facial palsy.